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Reflectance-mode confocal microscopy of pigmented skin lesions--improvement in melanoma diagnostic specificity.

BACKGROUND: In vivo confocal microscopy enables skin visualization with a quasihistopathologic resolution. OBJECTIVE: We sought to describe confocal features in melanocytic lesions and to evaluate their diagnostic significance for melanoma (MM) identification. METHODS: Thirty seven MMs, 49 acquired nevi, and 16 Spitz/Reed nevi, presenting equivocal clinicodermoscopic aspects were investigated by confocal microscopy. RESULTS: MMs and nevi significantly differed for some aspects. In multivariate analysis, the presence of nonedged dermal papillae, atypical cells, and isolated nucleated cells within dermal papilla, pagetoid cells, widespread pagetoid infiltration, and cerebriform clusters were strongly correlated with MM diagnosis. A receiver operating characteristic curve value of 0.952 was obtained. LIMITATIONS: Spitz/Reed nevi represented a pitfall in confocal diagnosis, owing to the frequent observation of pagetoid infiltration, architectural disarray, and cytologic atypia, and to the impossibility of evaluating cell maturation with depth. CONCLUSION: Characterization of confocal microscopy features of MMs and nevi seems to improve diagnostic accuracy for melanocytic lesions that are difficult to diagnose.

Diagnosis, Differential↗

A simple classification of the resolution and depth of imaging systems for pigmented skin lesions.

The resolving power of imaging systems used in the diagnosis of cutaneous malignant melanoma is usually presented in the literature in terms of numerical values, yet it is often difficult for the reader to ascertain what tangible information these systems are extracting. This paper presents a classification system of two aspects of imaging systems that allows rapid appraisal of the resolution of the different imaging systems used in the diagnosis of melanoma and the additional clinical information they reveal.

Diagnostic Imaging↗

An integrated computer supported acquisition, handling, and characterization system for pigmented skin lesions in dermatological images.

This paper describes an integrated prototype computer-based system for the characterization of skin digital images. The first stage includes an image acquisition arrangement designed for capturing skin images, under reproducible conditions. The system processes the captured images and performs unsupervised image segmentation and image registration utilizing an efficient algorithm based on the log-polar transform of the images' Fourier spectrum. Border- and color-based features, extracted from the digital images of skin lesions, were used to construct a classification module for the recognition of malignant melanoma versus dysplastic nevus. Different methods, drawn from the fields of artificial intelligence (neural networks) and statistical modeling (discriminant analysis), were used in order to find the best classification rules and to compare the results of different approaches to the problem.

Algorithms↗